The much publicized deadline of May 15 for enrolling in a drug plan under the Medicare drug benefit has come and gone, but there are plenty of people in California who can sign up any day and enjoy the benefit at little or no cost. However, this group of beneficiaries is both poor and hard to reach, so they might face obstacles receiving the benefits legislators wrote into the 2003 Medicare law.
The federal government waived the May 15 enrollment deadline to accommodate the search for people eligible for the low-income subsidy, but beneficiaries in this group too often “don’t know about or understand the benefit of the program to them,” according to Jeanne Finberg, directing attorney at the National Senior Citizens Law Center in Oakland.
Finding them and enrolling them is proving a daunting challenge for the advocacy community.Advocacy Groups Pursue Enrollment Agenda
The National Council on the Aging (NCOA) is working through local coalitions of community groups to locate and enroll eligible beneficiaries for the financial help. AARP also is working to identify eligible beneficiaries. But it’s a tough job because many of the eligible beneficiaries don’t read newspapers, some have limited English language skills, and beneficiaries are often suspicious of government programs.
“It’s a tough group to reach,” said Marisa Scala-Foley, associate director of the Access to Benefits Coalition, organized by NCOA to help people enroll in Medicare and other government programs. A particular problem for Part D, she noted, is the two-step process: first, getting people to apply and be certified by Social Security for the low-income subsidy, and second, enrolling them in a prescription drug plan. “Whenever you add a step to any process, some people feel intimidated and you may lose them along the way,” she said.
One new strategy to reach these beneficiaries is “mining” lists of people likely to be eligible, including those who are already enrolled in programs for low-income people. To identify beneficiaries who might be eligible for the subsidies, advocates are consulting enrollment data covering federal aid to pay heating and cooling bills, Meals on Wheels services and programs that currently help beneficiaries pay their monthly Medicare premiums for coverage of doctor bills. Local coalitions are getting client lists from various agencies to send letters to people who might be eligible, Scala-Foley said.
Advocates have reached out to community groups. In Orange County, one “of our community partners runs a door-to-door program that identifies Latino seniors in the community who have unmet health needs,” according to Cheryl Meronk, Health Insurance Counseling and Advocacy program manager. “We are hoping to work with this organization to send a similar letter to those in their database who have been identified as having Medicare, no Medicaid, and meeting the income criteria.”
Advocates also are scheduling events at senior centers, libraries and areas with subsidized apartments for low-income people.
Seeking out those eligible for the financial aid and persuading them to apply for it is a laborious process. “It pretty much will be a one-on-one slog as you encounter these people and explain the program,” said Jack Christy, director of public policy for the California Association of Homes and Services for the Aging.Dual Eligibles at Risk
In addition to locating and enrolling beneficiaries who are eligible for extra assistance, advocacy and counseling groups have faced difficulties working with enrolled beneficiaries to ensure that they receive benefits as intended under the drug benefit.
A particularly challenging instance in California was the case of beneficiaries who are dually eligible for Medicare and Medi-Cal and receive medications for mental illnesses. The new Medicare law created mass confusion for many dual eligibles because it does not cover certain of their popular prescriptions.
“You’re dealing with a population with cognitive disabilities and health issues, and they are a very vulnerable population,” said Eli Gelardin — program director at the Marin Center for Independent Living, which helps 2,000 people with mental illness stay in their communities.
Gelardin and his staff, like other counselors all over California, spent many hours in counseling and advocacy, first making sure that pharmacies participating in the drug benefit knew to which PDPs people had been assigned, a process intended to make it easier for beneficiaries to receive medications.
But there was a special twist for the dual eligibles with mental illnesses. The new Medicare benefit does not cover a class of drugs known as benzodiazepines, which often are used to treat mental illnesses. However, California elected to continue coverage of these medications through Medi-Cal. That means Gelardin and other advocates had to contact Medi-Cal on behalf of dual eligibles with prescriptions for such treatments to ensure that Medi-Cal had notified pharmacies of the state’s coverage policy for benzos.
“This requires a lot of legwork,” he said. “It could take several days’ communicating between several bureaucratic agencies.”
The failure to effectively reach many of the people eligible for the low-income subsidy is one of the big gaps in the Medicare drug benefit effort. Despite a massive enrollment drive, as many as five million people have no drug coverage: they have not been enrolled in any Medicare Part D plan, or do not have previous coverage from another source. Most of them, an estimated three million, are eligible for the low-income subsidy, but haven’t been reached and enrolled.
SSA mailed letters to 19 million people who might be eligible for the low-income subsidy and inviting them to apply. The federal government originally estimated that about eight million Medicare beneficiaries were eligible for the subsidy. About four million beneficiaries submitted applications, but more than half were ineligible because their assets’ value exceeded $11,500 for individuals, or $23,000 for married couples. SSA has approved about 1.7 million beneficiaries to receive the assistance.
At a recent hearing of the House Ways and Means Committee, NCOA President and CEO James Firman testified about the importance to health care advocates of these enrollment efforts. “The promise and potential of the Medicare Modernization Act will not be realized until we find and enroll all of the people who are eligible for and not receiving the extra help available to them,” he said.